Transjugular Intrahepatic Portosystemic Shunt: A Possible Risk Factor for Direct‐Acting Antiviral Treatment Failure in Patients With Hepatitis C?

Piecha, Felix; Gänßler, Jan-Michael; Jordan, Sabine; Ergen, Can; Ittrich, Harald; Kluwe, Johannes; Pischke, Sven; Lohse, Ansgar W.; Wiesch, Julian Schulze zur

doi:10.1002/hep4.1337

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…Furthermore, only two patients failed more than two DAA treatment courses, of which one patient received treatment after placement of a transjugular intrahepatic portosystemic shunt (TIPS). Therefore, we hypothesize that failing multiple treatments might be limited to a certain subgroup of patients with a combination of unfavorable baseline characteristics like decompensated liver cirrhosis, extensive RAS or previous TIPS placement [25]. Therefore, an individualized treatment concept that takes all individual risk factors into account is warranted in these patients.…”

Section: Sof/ldv+rbv [Svr%]mentioning

confidence: 99%

Treatment and re-treatment results of HCV patients in the DAA era

et al. 2020

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Background Re-treatment in patients with a chronic hepatitis C virus (HCV) infection and a previous failure to direct-acting antiviral (DAA) treatment remains a challenge. Therefore, we investigated the success rate of treatment and re-treatment regimens used at our center from October 2011 to March 2018. Methods A retrospective analysis of DAA-based HCV therapies of 1096 patients was conducted. Factors associated with a virological relapse were identified by univariable and multivariable logistic regression, treatment success of the re-treatment regimens was evaluated by an analysis of sustained virological response (SVR) rates in patients with a documented followup 12 weeks after the end of treatment. Results Of 1096 patients treated with DAA-based regimens, 91 patients (8%) were lost to follow-up, 892 of the remaining 1005 patients (89%) achieved an SVR12. Most patients (65/113, 58%) who experienced a virological relapse received an interferon-based DAA regimen. SVR rates were comparable in special cohorts like liver transplant recipients (53/61, 87%) and people with a human immunodeficiency virus (HIV) coinfection (41/45, 91%). On multivariable analysis, interferon-based DAA therapy was associated with treatment failure (odds ratio 0.111, 95%-confidence interval 0.054-0.218) among others. One hundred seventeen patients with multiple DAA treatment courses were identified, of which 97 patients (83%) experienced a single relapse, but further relapses after two (18/117, 15%) or even three (2/ 117, 2%) treatment courses were also observed. Eighty-two of 96 (85%) re-treatment attempts with all-oral DAA regimens were successful after an initial treatment failure.

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Section: Sof/ldv+rbv [Svr%]mentioning

confidence: 99%

Treatment and re-treatment results of HCV patients in the DAA era

et al. 2020

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“…prospective, randomized trial comparing TIPS to LVP 8 in patients with only recurrent ascites and a limited paracentesis frequency, which demonstrated a survival benefit in TIPS-treated patients. Therefore, we suggest that a TIPS should be considered early in patients with a stable underlying liver disease whose kidney function is beginning to be impaired, whereas in patients with an HCV-associated liver cirrhosis, treatment of the underlying disease with direct-acting antivirals should be considered first 31 to improve liver function. Furthermore, our data clearly indicate that patients with persistent ascites after TIPS have a decreased transplant-free survival.…”

Section: Survival Probabilitymentioning

confidence: 99%

Ascites control by TIPS is more successful in patients with a lower paracentesis frequency and is associated with improved survival

et al. 2019

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Cohort of 128 patients with refractory ascites TIPS Ascites control (95/128) Persistent ascites (33/128) Effect of persistent ascites on transplant-free survival Conclusion: ConsiderTIPS "early" in ascitic decompensation Ascites control is associated with transplant-free survival Ascites control by TIPS is more successful in patients with a lower paracentesis frequency and associated with improved survival Rik factors for persistent ascites:

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“…There is some evidence to support that a transjugular intrahepatic portosystemic shunt (TIPS) may be a risk factor for DAA failure due to the impact on pharmacokinetic and pharmacodynamic properties. A small retrospective study found that SVR was achieved in 3/3 patients treated with SOF/VEL/VOX without a TIPS versus 0/1 patients treated with SOF/VEL/VOX with a TIPS 29. Post-transplant patient studies are lacking; however, one case report showed successful SVR in a post-liver transplant, DAA-experienced patient with genotype 3 HCV 30.…”

Section: Methodsmentioning

confidence: 99%

<p>Profile of sofosbuvir/velpatasvir/voxilaprevir in the treatment of hepatitis C</p>

Childs‐Kean¹,

Brumwell²,

Lodl³

2019

IDR

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The treatment of chronic hepatitis C has been revolutionized with the introduction of direct-acting antivirals (DAAs). However, some patients are not cured with first-line treatment. Sofosbuvir/velpatasvir/voxilaprevir is a fixed-dose combination of a polymerase inhibitor, an NS5A inhibitor, and a protease inhibitor with activity against strains of the hepatitis C virus that show resistance to other first-line antiviral regimens. Sofosbuvir/velpatasvir/voxilaprevir has been studied in four Phase III randomized trials: POLARIS-1, −2, −3, and −4, which enrolled both treatment naïve and experienced patients with and without compensated cirrhosis. In these trials, at least 95% of patients treated with sofosbuvir/velpatasvir/voxilaprevir achieved sustained virological response (SVR). This includes favorable treatment outcomes in patients who had previously failed a regimen containing sofosbuvir or an NS5A inhibitor. Patient-reported outcomes also improved during and after treatment with sofosbuvir/velpatasvir/voxilaprevir. Treatment with sofosbuvir/velpatasvir/voxilaprevir is well tolerated, with the most commonly reported adverse events being headache, fatigue, diarrhea, and nausea. The approval of sofosbuvir/velpatasvir/voxilaprevir allows a treatment option for patients who have failed treatment with certain DAA regimens.

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Transjugular Intrahepatic Portosystemic Shunt: A Possible Risk Factor for Direct‐Acting Antiviral Treatment Failure in Patients With Hepatitis C?

Cited by 4 publications

References 10 publications

Treatment and re-treatment results of HCV patients in the DAA era

Treatment and re-treatment results of HCV patients in the DAA era

Ascites control by TIPS is more successful in patients with a lower paracentesis frequency and is associated with improved survival

<p>Profile of sofosbuvir/velpatasvir/voxilaprevir in the treatment of hepatitis C</p>

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